<form id="paymentDetailsForm" name="paymentDetailsForm" action="https://secure.net-a-porter.com/psp/payment" method="POST">
  <input id="paymentSessionId" name="paymentSessionId" type="hidden" value="a530fe50d17324e5a822b3bc020ccd28">
  <input id="redirectUrl" name="redirectUrl" type="hidden" value="https://www.net-a-porter.com/ca/en/purchasepath.nap?execution=e1s3&amp;_eventId=processPayment&amp;submittedToken=bc9d9248-dae1-44d7-be4e-f1ae5a493bfb&amp;pspPaymentSessionId=a530fe50d17324e5a822b3bc020ccd28">
  <input id="customerId" name="customerId" type="hidden" value="0">
  <input id="site" name="site" type="hidden" value="nap_am">
  <input id="adminId" name="adminId" type="hidden" value="0">

  <div class="sectionheader" id="payment_header">
    <h2 id="enter_payment_details_heading">
      4. ENTER PAYMENT DETAILS
    </h2>

  </div>

  <a id="cardform"></a>

  <div class="section" id="cc_errors">
    <div class="section" id="cc_errors_ul">
    </div>
  </div>

  <div class="silver payment-info-note">
    <p><strong>Please note</strong> that the value of your order will only be charged to your card at the time of delivery</p>
  </div>

  <div class="section card-form" id="ccard_form">

    <div class="payment-form-container">
      <input name="savedCard" value="false" type="hidden">

      <div id="ccfield_large_icons" class="ccfield-choose">
        <div class="cc-card-wrap">

          <div class="cc-type type-visa">
            <label for="visa"> <span title="Visa" class="card-icon card-icon-visa"></span> </label>
            <input type="radio" value="VISA" id="visa" title="Visa" name="cardType" checked="checked">
          </div>

          <div class="cc-type type-mastercard">
            <label for="mastercard"> <span title="Mastercard" class="card-icon card-icon-mastercard"></span> </label>
            <input type="radio" value="MASTERCARD" id="mastercard" title="MasterCard" name="cardType">
          </div>

          <div class="cc-type type-amex">
            <label for="amex"> <span title="American Express" class="card-icon card-icon-amex"></span> </label>
            <input type="radio" value="AMEX" id="amex" title="American Express" name="cardType">
          </div>

          <div class="cc-type">
            <h3 class="payment-or">or</h3>
          </div>
        </div>

        <div class="cc-paypal-wrap">
          <div class="cc-type type-paypal">
            <label for="paypal">
              <span title="PayPal" class="card-icon card-icon-paypal"></span>
            </label>
            <input type="radio" value="PAYPAL" id="paypal" title="PayPal" name="cardType">
          </div>
        </div>

        <span id="selectCardError" class="paymentError error"></span>
      </div>
      <div id="card-detail-fields">
        <table>
          <tbody>
            <tr class="error-line">
              <td class="form-label"></td>
              <td>
                <span id="cardError" class="paymentError error"></span>
                <span id="cardErrorMobile" class="paymentErrorMobile error"></span>
              </td>
            </tr>
            <tr class="field_row">
              <td class="form-label">
                <label for="card_number">Card Number*</label>
              </td>
              <td>
                <input type="tel" name="cardNumber" size="35" class="text form-field" id="card_number" value="" placeholder="">
              </td>
            </tr>

            <tr class="error-line">
              <td class="form-label"></td>
              <td>
                <span id="nameError" class="paymentError error"></span>
                <span id="nameErrorMobile" class="paymentErrorMobile error"></span>
              </td>
            </tr>
            <tr class="field_row">
              <td class="form-label">
                <label for="cardholders_name">Name on card*</label>
              </td>
              <td>
                <input name="cardHoldersName" size="35" id="cardholders_name" class="text form-field" type="text" placeholder="">
              </td>
            </tr>

            <tr class="error-line">
              <td class="form-label"></td>
              <td>
                <span id="cvsError" class="paymentError error"></span>
                <span id="cvsErrorMobile" class="paymentErrorMobile error"></span>
              </td>
            </tr>
            <tr class="field_row">
              <td class="form-label">
                <label for="security_number">Security Number*</label>
              </td>
              <td>
                <input type="tel" name="cVSNumber" maxlength="4" size="3" id="security_number" class="security_number" placeholder="">
                <a id="cc-security-link" class="text-link" onclick="launchPopUp( this.href, 455, 350); return false;" href="http://www.net-a-porter.com/am/content.nap?page=Card-Security-Code&amp;pgForward=popup" title="What is the security number?">
                  What is this?
                </a>
              </td>
            </tr>
            <tr class="error-line">
              <td class="form-label"></td>
              <td>
                <span id="expiryError" class="paymentError error"></span>
                <span id="expiryErrorMobile" class="paymentErrorMobile error"></span>
              </td>
            </tr>
            <tr class="field_row">
              <td class="form-label expiry-date">
                <label for="expiry_month">Expiry Date*</label>
              </td>
              <td>
                <select name="expiryMonth" class="date form-field" id="expiry_month">
                  <option value="">Month</option>
                  <option value="01">01</option>
                  <option value="02">02</option>
                  <option value="03">03</option>
                  <option value="04">04</option>
                  <option value="05">05</option>
                  <option value="06">06</option>
                  <option value="07">07</option>
                  <option value="08">08</option>
                  <option value="09">09</option>
                  <option value="10">10</option>
                  <option value="11">11</option>
                  <option value="12">12</option>
                </select>
                <select name="expiryYear" class="date form-field" id="expiryYear">
                  <option value="">Year</option>
                  <option value="16">16</option>
                  <option value="17">17</option>
                  <option value="18">18</option>
                  <option value="19">19</option>
                  <option value="20">20</option>
                  <option value="21">21</option>
                  <option value="22">22</option>
                  <option value="23">23</option>
                  <option value="24">24</option>
                  <option value="25">25</option>
                  <option value="26">26</option>
                  <option value="27">27</option>
                </select>
              </td>
            </tr>
            <tr class="empty-line"></tr>

            <tr>
              <td>
                <input type="hidden" name="keepCard" value="false">
              </td>
            </tr>
          </tbody>
        </table>
      </div>
    </div>
  </div>
  <div class="section pp-box">
    <div id="purchase_path_back_button">
      <a href="//www.net-a-porter.com/ca/en/purchasepath.nap?execution=e1s3&amp;_eventId=back" class="secondary-button">Back</a>
    </div>
    <input type="submit" name="_eventId_processPayment" id="processPayment" class="inlineright primary-button" value="Purchase Now">
  </div>
</form>
